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Drug-Eluting Stent as an Option for Intractable In-Stent Coronary Restenosis
Hachinohe, Daisuke,Jeong, Myung Ho,Kim, Min Chol,Cho, Kyung Hoon,Ahmed, Khurshid,Hwang, Seung Hwan,Lee, Min Goo,Sim, Doo Sun,Park, Keun-Ho,Kim, Ju Han,Hong, Young Joon,Ahn, Youngkeun,Kang, Jung Chaee The Korean Society of Cardiology 2011 Korean Circulation Journal Vol.41 No.11
<P>A 51-year-old man was admitted due to an acute anterior ST-segment elevation myocardial infarction. After thrombolytic therapy using recombinant tissue plasminogen activator, stent implantation was performed from the proximal left anterior descending artery (LAD) to the mid LAD using a bare-metal stent (BMS). Since then, the patient suffered five repeated episodes of in-stent restenosis (ISR). At the first ISR, he was treated with plain old balloon angioplasty (POBA). At the second ISR, he was treated with brachytherapy, and at the third ISR, he was treated with POBA and one more BMS distal to the previously implanted stent. At the forth, only POBA was performed, and finally, at the fifth ISR, a sirolimus-eluting stent was implanted. Following that, the patient remained asymptomatic and follow-up coronary angiography showed no ISR.</P>
Drug-Eluting Stent as an Option for Intractable In-Stent Coronary Restenosis
Daisuke Hachinohe,정명호,김민철,조경훈,Khurshid Ahmed,황승환,이민구,심두선,박근호,김주한,홍영준,안영근,강정채 대한심장학회 2011 Korean Circulation Journal Vol.41 No.11
A 51-year-old man was admitted due to an acute anterior ST-segment elevation myocardial infarction. After thrombolytic therapy using recombinant tissue plasminogen activator, stent implantation was performed from the proximal left anterior descending artery (LAD) to the mid LAD using a bare-metal stent (BMS). Since then, the patient suffered five repeated episodes of in-stent restenosis (ISR). At the first ISR, he was treated with plain old balloon angioplasty (POBA). At the second ISR, he was treated with brachytherapy, and at the third ISR, he was treated with POBA and one more BMS distal to the previously implanted stent. At the forth, only POBA was performed, and finally, at the fifth ISR, a sirolimus-eluting stent was implanted. Following that, the patient remained asymptomatic and follow-up coronary angiography showed no ISR.
( Daisuke Hachinohe ),( Myung Ho Jeong ),( Shigeru Saito ),( Min Chol Kim ),( Kyung Hoon Cho ),( Khurshid Ahmed ),( Seung Hwan Hwang ),( Min Goo Lee ),( Doo Sun Sim ),( Keun-Ho Park ),( Ju Han Kim ),( 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.4
Background/Aims: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). Methods: This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method. Results: At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). Conclusions: Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
홍영준,정명호,손선정,심두선,김정하,임경섭,Daisuke Hachinohe,Khurshid Ahmed,황승환,이민구,고점석,박근호,윤현주,윤남식,김계훈,박형욱,김주한,안영근,조정관,조동련,박종춘,강정채 대한심장학회 2011 Korean Circulation Journal Vol.41 No.9
Background and Objectives: The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neointimal hyperplasia, and a role for angiotensin II in the migration and proliferation of vascular smooth muscle cells in restenotic lesions has been proposed. The aim of this study was to determine the anti-proliferative and anti-inflammatory effects of ramiprilat-coated stents in a porcine coronary overstretch restenosis model. Subjects and Methods: Pigs were randomiz-ed into two groups in which the coronary arteries {16 pigs (16 coronaries in each group)} had a 3.0×17 mm ramiprilat-coat-ed MAC stent or a 3.0×17 mm control MAC stent (AMG, Munich, Germany) implanted with oversizing (stent-to-artery ratio, 1.3 : 1) in porcine coronary arteries, and histopathologic analysis was assessed 28 days after stenting. Results: There were no significant differences in the injury and inflammation scores between the two groups (1.20±0.43 vs. 1.23±0.57, p=0.8; and 1.21±0.39 vs. 1.25±0.49, p=0.6, respectively). Within the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations existed between inflammatory cell counts and the neointima areas (r=0.567, p<0.001), and between inflammatory cell counts and the percent area stenosis (r=0.478, p<0.001). There was no significant difference in the in-flammatory cell counts normalized to the injury (110±89 vs. 123±83, p=0.4) and fibrin scores (0.15±0.06 vs. 0.17±0.07, p= 0.8) between the 2 groups. There were trends toward a smaller neointima area (1.06±0.51 mm2 vs. 1.28±0.35 mm2, p=0.083) and a smaller percent area stenosis (18.9±8.7% vs. 21.8±7.2%, p=0.088) in the ramiprilat-coated stent group. Conclusion: Although the ramiprilat-coated stent did not show significant inhibitory effects on neointimal hyperplasia, the ramiprilat-coated stent showed good effects on the inflammatory reaction and arterial healing similar to the control stent in a porcine co-ronary restenosis model.
( Doo Sun Sim ),( Myung Ho Jeong ),( Daisuke Hachinohe ),( Youngkeun Ahn ),( Myeong Chan Cho ),( Chong Jin Kim ),( Young Jo Kim ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Background:The role of thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PPCI) remains a matter of controversy. Methods and Results: A total of 2,105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry, a cohort of 745 (35.4 %) patients who underwent TA during PPCI was compared with 1,360 (64.6 %) patients who underwent conventional PCI without TA. Clinical outcomes at 12-month of overall enrolled patients and subgroups according to key variables were assessed using Cox regression models adjusted by propensity score. Although there was no significant difference among overall patients, in subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitor during PPCI [adjusted hazard ratio (HR) 0.329, 95 % confidence interval (CI) 0.126 to 0.860, p=0.023] and left anterior descending (LAD) as a culprit lesion (adjusted HR 0.516, 95 % CI 0.275 to 0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA. Conclusions: Although TA does not improve clinical outcomes in overall patients who underwent PPCI, TA for LAD occlusion improves 12-month MACE. Furthermore, use of GP IIb/IIIa inhibitor with TA has synergetic effect on clinical outcomes.